Eating Disorders and Their Medical Symptoms

Frederick R. Jelovsek MD

Eating disorders -- anorexia nervosa, bulimia nervosa and binge-eating disorder -- occur most commonly in adolescent girls or young women. The death rate from anorexia nervosa is 0.5% a year. Over 50% of eating disorders go unrecognized and it is thought that an estimated 3% of young women have these illnesses. A review article, Becker AE, Grinspoon SK, Klibanski A, Herzog DB: Eating Disorders. N Engl J Med 1999; 340:1092-1098. helps answer some of the questions about this unrecognized group of problems.

What are diagnostic criteria for these eating disorders?

Anorexia nervosa

Body weight less than 85% of expected weight or body mass index (BMI) less than 17.5

eating very rapidly eating until uncomfortably full eating when not hungry eating alone feeling disgusted or guilty after a binge

No recurrent purging, excessive exercise or fasting

Absence of anorexia nervosa

Other (atypical) eating disorders

Clinically important disordered eating, inappropriate weight control, or excessive concern about body weight or shape that does not meet all the criteria for anorexia nervosa, bulimia nervosa, or binge-eating disorder.

How can I recognize an eating disorder in someone else?

There are both body changes and behavioral changes that may signal an eating disorder. Bodily changes may include:

arrested growth

marked change or frequent fluctuation in weight

inability to gain weight

fatigue

constipation or diarrhea

susceptibility to fractures

delayed onset of first menses

abnormal levels of blood chemistries

Behavioral changes may include:

change in eating habits

difficulty eating in social settings

reluctance to be weighed

depression

social withdrawal

absence from school or work

deceptive or secretive behavior

stealing (e.g., to obtain food)

substance abuse

excessive exercise

What is considered underweight or over weight?

While different criteria have been used by various medical groups the following levels are adapted from the Harvard Eating Disorders Center in Boston.

What are some of the medical complications of anorexia or bulimia?

There are many complications of these disorders. In the oral cavity, there can be increased dental caries, gum disease, parotid gland enlargement and swollen lymph nodes under the jaw. In the cardiovascular system, hypotension, EKG changes, slow heart rate, heart enlargement and mitral valve prolapse can be seen. Liver and pancreas damage, esophagitis, constipation and rectocoele are gastrointestinal manifestations commonly seen.

Since women with these disorders have no menses or ovarian ovulation, the secondary effects of low estrogens cause delay in puberty, osteoporosis, infertility, lipid abnormalities, euthyroid sick syndrome, and other endocrine or chemical disturbances. During pregnancy, insufficient weight gain and low birthweight babies occur.

Finally, skin changes such as dry skin and hair, hair loss, yellow skin and hand abrasions may be part of the clinical picture. Women may also have anemia, low white blood cell counts or low platelets, and even peripheral nerve problems.

How successful are the treatments for these eating disorders?

About half of women who have anorexia nervosa or bulimia nervosa will have a full recovery if they get in a psychiatric counselling program. Approximately 30% have a partial recovery and 20% have no substantial improvement in symptoms. Only if the weight gets to be 75% or less of expected body weight is hospitalization usually necessary. Psychopharmacologic therapy is less successful in anorexia and more commonly used with bulimia nervosa. Estrogens and regulation of menses or the prevention of hypoestrogenic complications must be individually applied.